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Congress: ECR25
Poster Number: C-15632
Type: Poster: EPOS Radiologist (scientific)
DOI: 10.26044/ecr2025/C-15632
Authorblock: T. Rostovtseva, M. Dolgushin, R. Nadelyaev; Moscow/RU
Disclosures:
Tatiana Rostovtseva: Nothing to disclose
Mikhail Dolgushin: Nothing to disclose
Rostislav Nadelyaev: Nothing to disclose
Keywords: Hybrid Imaging, Neuroradiology brain, PET-MR, Molecular imaging, Seizure disorders
Purpose    Epilepsy is one of the most common neurological disorders, affecting around 50 million people worldwide [1].  Despite the versatile variety of anti-epileptic drugs, about 20-30% of patients resist conservative treatment [2]. Brain surgery has been considered the most effective option for the patients with pharmacoresistant epilepsy. The effectiveness of surgery in patients with pharmacoresistant epilepsy vary markedly (from 30 to 90%), according to the literature, that diversity can be explained by the differences in population and surgical option, but...
Read more Methods and materials       30 patients with pharmacoresistant epilepsy underwent scalp Video-EEG monitoring (Neuron-Spectr 4P, Neurosoft, Russia) and  18F-FDG PET/MRI of the brain (Signa PET/MRI, GE Healthcare, USA). Long-term-video-EEG monitoring included analysis of bioelectric brain activity during active and passive wakefulness with standard functional tests (hyperventilation, photostimulation). The standardized patient preparation for the PET was performed according to the European guideline (2009). 25 min list-mode 3D PET acquisition was performed with direct attenuation correction using MRI Dixon sequences. Specialized epilepsy MRI scanning...
Read more Results    The first group of patients consisted of 10 surgically treated patients, in the 8 of the patients (80%) epileptogenic lesion was visible on MRI (mesial temporal sclerosis-4, focal cortical displasia-1, subependymal nodular grey matter heterotopia-1, multinodular and vacuolating neuronal tumor-1, arachnoid cyst-1), in 2 patients (20%) structural changes of the brain were not observed on MRI. Area of 18F-FDG hypometabolism was found in all of the patients, its location matched with structural epileptogenic lesion in all 8 patients with...
Read more Conclusion    Precise localization of the epileptogenic zone and making treatment strategy  in patients with pharmacoresistant epilepsy are complicated and require multimodal imaging and multidisciplinary team approach. Simultaneous hybrid interictal PET/MRI technology may make significant contribution to the clinical decision-making, which is of particular importance in patients with discordant electroclinical and imaging data and MR-negative pharmacoresistant epilepsy. 
Read more References 1.Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al. Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies. Neurology. (2017) 88:296–303. 10.1212/WNL.0000000000003509.2.Picot MC, Baldy-Moulinier M, Daures JP, Dujols P, Crespel A. The prevalence of epilepsy and pharmacoresistant epilepsy in adults: a population-based study in a Western European country. Epilepsia. 2008;49(7):1230–1238. doi: 10.1111/j.1528-1167.2008.01579.x. 3.Witt JA, Krutenko T, Gädeke M, Surges R, Elger CE, Helmstaedter C. Accuracy of expert predictions of seizure freedom after...
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